Dame Carol Black maps the path to a healthier future

17 March 2008

National Director for Health and Work, Dame Carol Black, has published her review of the health of Britain's working age population. 'Working for a healthier tomorrow' calls for urgent and comprehensive reform and a new approach to health and work in Britain.

A vision of a healthier Britain was unveiled today by Dame Carol Black as she proposed radical changes to work-related health services making them available to all. The National Director for Health and Work published the first ever review into the health of the working age population – Working for a Healthier Tomorrow – calling for urgent and comprehensive reform and a new approach to health and work in BritainThe review recognises that for most people work is good both for their long-term health and for their family’s well-being. Its proposals focus on keeping people healthy at work, and also on helping them return to work if they get ill. The review found that ill health was costing the country £100 bn a year – enough to run the entire NHS. But Dame Carol emphasised that although the economic cost was substantial, the human cost to families was immeasurable.

‘For most people their work is a key factor in their self-worth, family esteem and identity. So if they become sick and are not helped quickly enough, they can all too easily find themselves on a downward spiral into long-term sickness and a life on benefits. This is not only devastating for them, but also for their families. Their children suffer financially, emotionally and it can affect their long-term futures. The aim of my review is not to offer a utopian solution for improved health in working life, but to identify factors that stand in the way and offer potential solutions.’

Dame Carol spells out the key challenges in the review, which include insufficient access to good work-related health support in the early stages of sickness, including mental health conditions. Provision is currently disproportionately concentrated among a few large employers, leaving the vast majority of small employers without support. Other issues include the current sick note process which concentrates on what people can’t do, instead of what they can.

Dame Carol makes key recommendations to overcome the challenges, including:

• New Fit for Work service to be piloted for patients in early stages of sickness – if rolled out the aim would be to make work-related health support available to all;
• If successful Fit for Work should be extended to those on incapacity and other out of work benefits. Government should also expand provision of Pathways to Work to cover all on incapacity benefit;
• Outdated paper-based sick note should be replaced with an electronic ‘fit note’, stating what people can do, not what they can’t;
• Occupational health should be brought into the mainstream of healthcare provision;

The review is the result of wide-ranging research and consultation including a series of events held around the country and a Call for Evidence which produced more than 260 responses. An important step was also the ground-breaking consensus statement signed by more than 30 health professional bodies, including the BMA and RCGP. They pledged to help people enter, stay in or return to work, where appropriate, because it is often in the patients’ best interests.

Professor Dame Carol Black is the National Director for Health and Work, Chairman of the Academy of Medical Royal Colleges and Chairman of the Nuffield Trust, and maintains a deep interest in both the clinical and research aspects of connective tissue diseases.